FoodShare Forms

Clicking the Assigned Number link will either download the selected form (if only one version is available) OR it will open a page that will display all language versions of that form. From that page you can choose and download the needed forms.
Assigned Numbersort descending Title Other Location
F-00098 Summary of Information Letter (PDF, 224 KB)
F-00107 Self-Employment Income Report
F-00107W Self-Employment Income Report Worksheet (PDF, 32 KB)
F-00136 FoodShare Employment and Training (FSET) Program Participation Agreement
F-00219 Self-Employment Income Report - Farmer
F-00219W Self-Employment Income Report - Farmer Worksheet (PDF, 32 KB)
F-00330 Request for Replacement FoodShare Benefits
F-00628 Consortium Response to the State IM Second Party Review Finding
F-01252 FoodShare Employment and Training (FSET) - Initial Appointment
F-01253 FoodShare Employment and Training (FSET) - Appointment Final Notice
F-01254 FoodShare Employment and Training (FSET) - Employment Plan (EP) Appointment
F-01255 FoodShare Employment and Training (FSET) - Job Club Appointment
F-01256 FoodShare Employment and Training (FSET) - Discuss FSET Participation
F-01257 FoodShare Employment and Training (FSET) - Workshop Appointment
F-01359 Historical Earnings Verification Request
F-01598 Medical Exemption from Work Requirement for Able-Bodied Adults Without Dependents
F-01733 FoodShare Outreach Project Proposal
F-01891 New Employment Reporting – FoodShare Employment and Training (FSET) Program
F-01983 Self-Employment Income Worksheet: Business Capital Gains or Losses (Form 4797)
F-01984 Self-Employment Income Worksheet: Sole Proprietorship (Schedule C or Schedule C-EZ)
F-01985 Self-Employment Income Worksheet: Personal Capital Gains or Losses (Schedule D)
F-01986 Self-Employment Income Worksheet: Sole Proprietorship (Schedule E)
F-01987 Self-Employment Income Worksheet: Sole Proprietorship (Schedule F)
F-10126 Medicaid / BadgerCare Plus / FoodShare Wisconsin Authorization of Representative
F-10138 BadgerCare Plus Supplement to FoodShare Wisconsin Application (PDF, 654 KB)
F-10140 Wisconsin Medicaid Supplement to FoodShare Wisconsin Application
F-10144 Life Insurance Inquiry
F-10146 Employer Verification of Earnings
F-10150 Your Rights and Responsibilities for Health Care / FoodShare
F-10150B Your Rights and Responsibilities for FoodShare
F-16001 Notice of Denial of Benefits/Negative Change in Benefits
F-16004 Add or Remove an Authorized Buyer or Alternate Payee for FoodShare Benefits
F-16006 FoodShare Wisconsin Change Report
F-16011 Quality Assurance (QA) Sample Check List (PDF, 226 KB)
F-16014 Notice of Program Violation (PDF, 43 KB)
F-16015 Notice of Approval of Benefits/Positive Change in Benefits
F-16019A FoodShare Wisconsin Registration / Important Information
F-16019B FoodShare Wisconsin Application / Registration
F-16022 Social Security Number Referral
F-16023 Striker Evaluation (PDF, 395 KB)
F-16024 Notice of Disqualification
F-16025 Disqualification Consent Agreement
F-16026 Prosecution Diversion Agreement (PDF, 251 KB)
F-16028 Notice of FoodShare Over issuance
F-16029 FoodShare Wisconsin Repayment Agreement
F-16030 FoodShare Wisconsin Under/Overissuance Worksheet and Overpayment Calculator
F-16033 FoodShare Worksheet (PDF, 45 KB)
F-16034 Self-Employment Income Worksheet - Corporation (PDF, 25 KB)
F-16035 Self-Employment Income Worksheet - Subchapter S Corporation (PDF, 28 KB)
F-16036 Self-Employment Income Worksheet - Partnership (PDF, 27 KB)

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Last Revised: December 23, 2014